Individual
PHILLIS BEBERMAN-JENNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4920 MAIN ST, SUITE 202, BRIDGEPORT, CT 06606
(203) 374-1515
(203) 374-4702
Mailing address
4920 MAIN ST, SUITE 202, BRIDGEPORT, CT 06606-1300
(203) 374-1515
(203) 374-4702
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
000424
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001004241
—
CT
01
—
0088T1
EMPIRE BC
NY
01
—
113568598
TRICARE
—
Enumeration date
06/08/2006
Last updated
05/19/2008
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